Provider Demographics
NPI:1396027595
Name:FERGUSON, LISA (CMT/CHT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CMT/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOQUEL AVE
Mailing Address - Street 2:190
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-214-2984
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE
Practice Address - Street 2:190
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-214-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor